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Penetrating traumatic brain injury

Case contributed by Francesco Macri
Diagnosis certain

Presentation

Man killed with a handgun shot at point black range to the forehead.

Patient Data

Age: 60 years
Gender: Male

CT Brain (annotated)

ct

A man sustained a handgun shot at very close distance. 3D images depict the bullet entry orifice at cutaneous and bone surfaces. The main bullet path was recognized by bone fragments, shrapnel and blood from the top downward at the right occipital side. A ricochet of a fragment of the bullet was identified by a blood track run out at left temporal area. No exit wound was found. 

Case Discussion

Man executed with a handgun shot to the head at very close range.

The trajectory from the top to downward is not typical for a suicide (best depicted on sagittal images).

The bone table inward or outward beveling is typically indicative of the entry or exit wound respectively. In this case, outward beveling (i.e. exit wound) was not present, because the bullet dissipated completely its kinetic energy crossing all skull structures. Thus the bullet had no more energy to break down the posterior bone wall of the skull. Line fractures and their features also give a lot of information about the first bone fracture according to the Puppe’s rule.

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